Original Article

The effects of environmental

pollution on the respiratory system of
children in Western Macedonia,
Greece
Sichletidis L, Tsiotsios I, Gavriilidis A, Chloros D, Gioulekas D, Kottakis I,
Pataka A
Pulmonary Clinic, Aristotle University of Thessaloniki
Laboratory for the Investigation of Environmental Diseases. Greece

Summary. The indoor and outdoor environmental pollution effects on the respiratory system of 3,559 children
aged 9-12 were studied. It was a cross-sectional and interlocal (geographical differentiation) study. The research
was conducted during the period between 2000-2001 in five cities of Western Macedonia and more particularly:
1046 children from Ptolemaida, 1249 children from Kozani, 466 from Florina, 419 from Kastoria and 379 from
Grevena. The study was performed by means of a questionnaire for the detection of respiratory diseases during
childhood, plus spirometry and rhinomanometry measurements. The diachronic quantitative analysis of
environmental pollutants was conducted by The Laboratory of Physics of the Atmosphere of the Aristotle University
of Thessaloniki.
The environmental pollution was found to have a detrimental effect on the respiratory system of children, mainly
attributable to the occurrence of rhinitis and infectious bronchitis. The highest prevalence of rhinitis (40.3%) and
infectious bronchitis (12.1%) was observed in Ptolemaida, which is a highly polluted region, whereas the lowest
(21.2% and 6.7%, respectively) was seen in Grevena, a non-polluted area. As for the indoor pollution, maternal
smoking was found to increase the prevalence of respiratory problems in children. Finally, the fathers educational
level and a past history of nursery school attendance increase the prevalence of respiratory diseases during childhood.

Keywords: children, asthma, rhinitis, epidemiology, pollution, Greece

Introduction exposure to accepted pollution limits is unknown. The

It has been previously shown that a history of
respiratory problems during childhood is correlated with
an increased risk of pathologic respiratory function and
chronic obstructive pulmonary disease during adulthood
[1]. It seems that the respiratory system of infants is
extremely sensitive to nonspecific stimuli [2,3], and this
hyper-reactivity evolves inversely to the age of its debut
[4,5]. Consequently, the protection of a childs
respiratory system ensures healthy lungs during
adulthood.
It is known that high levels of environmental
pollution affect the morbidity and mortality from
respiratory diseases. However, the effect of long-lasting
epidemiological studies conducted worldwide focus
mainly on adults in whom both smoking and occupational
exposure complicate the environmental pollution effects
[6]. It seems that the exposure to road traffic pollution is
associated with a higher risk for a sensitization to pollen
and this could possibly be interpreted as an indication for
interactions between pollen and air pollutants that may
enhance the development of respiratory disorders [7].
Likewise, moderate levels of air pollutants exacerbate
rhino-conjunctivitis symptoms in pollen-allergic
individuals [8].
It is also known that the respiratory system is affected
by several other factors such as the socioeconomic status
[9], the number of family members in relation to

J Invest Allergol Clin Immunol 2005; Vol. 15(2): 117-123 2005 Esmon Publicidad
 Effects of environmental pollution on the respiratory system of children
residencial space [8], the existence and nature of
respiratory disease of co-habitants [10] and their
smoking habits [11,12], and the kind of the heating and
cooking sources [13].
The increased levels of air pollution augment the rate
of respiratory symptoms and illnesses among children
even in countries with moderate average concentration
of pollutants [14]. In Greece, the epidemiological
investigations of respiratory diseases during childhood
are few [15,16] and limited to the study of respiratory
function parameters or the occurrence of symptoms in
relation to the environmental pollution.
The objective of this study was the investigation of
the effect of indoor and outdoor environmental pollution
on the respiratory system of children aged 9-12. We
studied children living in the cities of Western
Macedonia, Greece (Ptolemaida, Kozani, Florina,
Kastoria and Grevena); cities presenting significant
differences as to the type and level of environmental
pollution and as to the prevailing socioeconomic
conditions.
Materials and Methods
1. Subjects
The study, performed during school year 2000-2001,
included a total 3,559 children of the last three courses
of the primary schools of Western Macedonia; City of
Ptolemaida (1046 children), Kozani (1249 children),
Florina (466 children), Kastoria (419 children) and
Grevena (379 children).
The cities of Kastoria and Grevena are considered
as the less polluted ones because of their low industrial
growth index. On the contrary, Ptolemaida, Kozani and
Florina are industrial regions par excellence.
A number of 1710 boys and 1849 girls living for at
least five years in the region under examination were
studied. All children were submitted to spirometry,
rhinomanometry and they were also provided with a
questionnaire.
a. Questionnaire
The questionnaire used was based on the Ferris [17]
questionnaire with some additions regarding
symptomatology of the upper respiratory system. The
questionnaires adequacy has been proven in various
epidemiological investigations conducted in children
[15,18]. It included questions on demographic data of the
children, educational level of the parents, living conditions
at home, factors of domestic pollution (smoking habits,
source used for heating and cooking), any respiratory
diseases of the family members and the presence of pets.
Through appropriate questions, it investigates the history
and symptomatology of the upper and the lower respiratory
system in children, any allergic reactions and the history
of infectious diseases during childhood.
The questionnaire was distributed to the children and
was filled in by the parents and collected one week later.
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118
b. Spirometry
Spirometric measurements were performed with the
use of a Vitalograph calibrated dry spirometer. After
explaining the purpose and the spirometry method,
the children performed at least three maximum efforts
[19].
c. Rhinomanometry
Following the method of anterior rhinomanometry
[20], nasal resistances and flows were defined with the
use of a Rhinotest mP 500 rhinomanometer.
Measurements were conducted at 150 Pascal (Pa) and
flows were measured at ml/sec.
2. Environmental pollution study
Monitoring of environmental pollution in the Eordea
valley was carried out by the Laboratory of Physics of
the Atmosphere, Aristotle University of Thessaloniki.
The study provided information about the cities of
Ptolemaida, Kozani and Florina. No measurements were
available for the cities of Kastoria and Grevena which
in our study were considered less polluted because of
their nonindustrial status.
3. Statistical analysis
The analysis of the results was performed with the
statistical packet SPSS with the independency-
homogeneity test 2 and with the Hierarchical Logistic
Linear Models technique. The odds ratio (OR) and the
relative risk (RR) were also calculated.
Results
A. Environmental pollution study
The main pollutant in the Eordea valley, where the
cities of Ptolemaida, Kozani and Florina are situated,
are the suspended particulates, mainly due to the surface
mining of lignite and the power steamed stations of the
Public Electrical Power Corporation. The concentrations
of total suspended particulate within the valley are, in
general, high. The maximum TSP concentrations are
observed in the city of Ptolemaida (mean value 132 g/
m3, max 380 g/m3) and they decrease with increasing
distance from city centre. At all station values over the
limit established by the World Health Organization
(WHO) for the suspended particulates (120 g/m3) are
daily detected [21]. Values above the limit of 250 g/
m3, which is the alert value for the cities of Athens and
Thessaloniki, are observed in many stations during
several days each year. Sulfur dioxide (SO2) does not
constitute a significant factor of air pollution since the
annual concentrations are lower than the limit reference
values. Grain size distribution analysis of all samples
showed that the inhaled fraction (<5 m) of fly ash is
always low, i.e. 9% on average.
For the other two cities, Grevena and Kastoria, there
are no measurements, since they are situated in non
industrial regions (Table 1).
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119 L. Sichletidis, et al.

Table 1. The prevalence of the upper and lower respiratory system diseases in children in five cities and their respective
pollution levels.

Ptolemaida Kozani Florina Kastoria Grevena Total

RR p
N: 1046 N: 1249 N: 466 N: 419 N: 379 N:3559

Rhinitis% 40.3 35.2 39.2 30.8 21.2 35.6 1.9 <0.001

Asthma% 6.9 5.4 6.2 8.4 6.3 6.4 1.5 NS
Infectious 12.1 8.1 10.1 9.7 6.7 9.6 1.8 <0.01
bronchitis%
Acute 17 12.3 14.1 13.3 7.1 13.5 2.4 <0.001
bronchitis%

TSP g/m3
Mean 132 88 56
Max 380 299 272
PM10 g/m3 86.3 64.2 58.3
SO2 g/m3
Mean 3 7 8
Max 14 13 70

B. Questionnaire analysis The prevalence of upper and lower respiratory system

Based on the answers of the questionnaire, it was
concluded that the prevalence of rhinitis presents an
uneven distribution among the 5 cities (p<0.001). The
relatively highest risk is detected in Ptolemaida and the
lowest one in Grevena, RR=1.9.
Positive answers that were given regarding
demonstration of dyspnea, cough or wheezing in
incidents without any symptoms of cold in children and
after intensive exercise, were considered indicative of
asthma. The prevalence of asthma also presents an
uneven distribution among the five cities reaching the
highest rate in Kastoria (8.4%) and the lowest (5.4%) in
Kozani (RR=1.5).
Infectious bronchitis, i.e. cough and expectoration
for a week or more was reported by 12.1% of the children
of Ptolemaida, and 6.7% in Grevena (RR=1.8). At least
one episode of acute bronchitis was included in the
history of 17% of the children of Ptolemaida and 7.1%
of the children in Grevena (RR=2.4) (Table 1).
diseases in children among the five cities varied
according to the geographical location. With regard to
rhinitis, infectious and acute bronchitis, statistically
significant differences were found; however, such
differences were not detected for bronchial asthma.
The examination of the children regarding the
occurrence of various types of allergy in relation to
asthma showed that 17.9% of the children with food or
skin allergy presented with asthma, in comparison with
4.2% of those without atopic manifestations (p<0.001).
According to our study, the presence of pets is a predisposing
factor for the development of asthma (Table 2).
Our analysis of the pollution factors in the domestic
environment in relation to the respiratory problems of
the children, showed that 2053 (58.5%) out of 3512 of
the fathers and 1373 (38.8%) out of 3539 of the mothers
were smokers. Smoking by the father did not seem to
affect the prevalence of the childrens respiratory
problems (bronchial asthma and rhinitis), whereas we

Table 2. Relations between atopy, presence of pets and prevalence of bronchial asthma and confidence limits (95%
Confidence Interval)

N Asthma % OR 95%CI P

Atopy Yes 705 126 17.9 5.93 4.46-7.90

No 2.854 101 3.5 1.00 Ref <0.001

Pets Yes 860 61 7.1 1.16 0.85-1.60

No 2.699 166 6.2 1.00 Ref NS

J Invest Allergol Clin Immunol 2005; Vol. 15(2): 117-123 2005 Esmon Publicidad
 Effects of environmental pollution on the respiratory system of children 120

Table 3. Relationship between prevalence of pulmonary diseases and domestic pollution

Smoking of Pulmonary
N % OR 95%CI P
father disease

Yes 2.053 613 29.8 1.05 0.90-1.22

No 1.506 435 28.9 1.00 Ref NS

Smoking of
mother

Yes 1.375 454 33 1.32 1.14-1.53

No 2.184 594 27.2 1.00 ref p<0.001

Heating

Radiators
Accumulators 3.288 964 29.3 1.00 Ref NS
Wood-petroleum
Gas 271 84 31 1.08 0.82-1.43

Cooking

Electrical cooker 3.495 1.028 29.4 1.00 Ref NS

Gas 64 20 31.2 1.09 0.62-1.91

found a close relationship between pulmonary diseases,
which was documented in 33% of the children, and
maternal smoking (Table 3).
The power and source used for heating or cooking
did not affect the prevalence of pulmonary diseases
(Table 3).
According to the results shown in table 4, the
educational level of the father seems to play an important
role in the occurrence of pulmonary disease (p<0.05),
and likewise the attendance to nursery school (p<0.001).
Finally, in order to define their financial status index,
families were asked about the power source they use

Table 4. Relationship between prevalence of pulmonary disease and living standards.

Living standards Pulmonary

Educational level N % OR 95%CI P
disease
of the father

N Primary 408 142 34.8 1.00 ref

3559 Secondary 2.366 683 28.9 0.75 0.60-0.95 p<0.05

Higher 785 223 28.4 0.74 0.57-0.96

Nursery school

N Yes 569 205 34.4 1.32 1.03-1.60

3559 No 2.963 843 28.4 1.00 Ref p<0.001

Economic
potential

N Low 765 241 31.5 1.13 0.95-1.35 NS

3559 High 2.794 807 28.9 1.00 ref

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121 L. Sichletidis, et al.
Table 5. Spirometry findings (as percentage % predicted) and nasal flows (ml/sec)
FVC% pred. FEV1% pred.
Ptolemaida 86.911.6 89.212.4
Kozani 89.812.2 9112.8
Florina 85.911.1 89.912.2
Kastoria 85.911.1 89.812.1
Grevena 88.212.1 91.212.9
for heating, i.e. diesel, wood or gas and whether two or
more people sleep in the same room with the child.
Based on the questionnaire analysis regarding the above
parameters (Table 4), we found an increase of pulmonary
diseases in children living in unfavorable economic
conditions, a difference, however, that did not attain
statistical significance.
Table 5 provides measured values of Forced Vital
Capacity (FVC), Forced Expiratory Volume in one
second (FEV1), FEV1/FVC% ratio, Forced Expiratory
Flow 25-75% (FEF25-75%) and rhinomanometry.
Spirometry values present no differences, whereas
nasal flows present statistically significant differences
(p<0.001) among the cities of Ptolemaida, Kozani and
Florina, on one hand, and Kastoria and Grevena, on the
other.
Discussion
Children living both in heavy polluted and in non-
polluted regions were enrolled in the study. The findings
of this study agree with the literature, i.e. symptoms from
the upper and lower respiratory system are more frequent
in children living in an air polluted environment.
The difference between polluted and non-polluted
areas was mostly related to the suspended particles in
the cities of Ptolemaida, Kozani and Florina with levels
almost constantly higher than the limits established by
the WHO.
Air pollutants, and more specifically suspended
particles, are released through the inhaled air passing
through the upper airways (nose) and thus leading to
the development of chronic infection of the airways [22-
24].
The high prevalence of chronic rhinitis and low
nasal flows observed mostly in Ptolemaida, Kozani and
Florina, may be due to the mechanism described above.
In the above three cities and in Kastoria, we observed
an increased prevalence of acute bronchitis and
particularly in Ptolemaida the occurrence of infectious
bronchitis. These findings may be attributed to the fact
that the exposure to high air pollution concentrations
increases the sensitivity to infections due to the
impairment of mucociliary clearance and macrophage
activity [25].
J Invest Allergol Clin Immunol 2005; Vol. 15(2): 117-123
FMF% pred. FEV1/FVC% FL.SUM
90.7119.8 91.75.7 479214
92.820.3 91.95.7 533285
91.728.9 92.15.5 515220
91.619.7 92.75.3 598156
92.819.7 92.14.9 689165
Bronchial asthma showed the highest prevalence in
Kastoria and the lowest one in Kozani. This could be
due to the higher socio-economic level of the inhabitants
of Kastoria compared with those of the other cities. The
pathogenetic relationship between bronchial asthma and
air pollution is not known. It is believed that the common
air pollutants studied do not cause asthma, however they
can lead to episodes of bronchospasm in subjects with
bronchial hyperreactivity. The SCARPOL study
provided evidence that while the symptom rates of
chronic cough and bronchitis augment with increasing
levels of air pollution, there is no association between
long-term exposure to air pollution and classic asthmatic
and allergic symptoms and illnesses [14].
The main pollutants of the domestic environment,
when wood, diesel or gas are used for heating and
cooking, are CO and NO2. A slight but important
relationship between NO2 increased levels indoors and
respiratory symptom prevalence has been reported [26-
28]. In our study we found that the use of gas, diesel or
wood for heating does not increase the prevalence of
symptoms from the respiratory system.
Cigarette smoke is considered to be an important
indoor pollutant and a predisposing factor for infections
[29] and increased bronchial reactivity [30,31], and
affects the development of the childrens respiratory
system [32]. Nevertheless, in this study the smoking
habit of the father was not found to lead to increased
respiratory symptoms in the child. However, an
important effect of smoking by the mother was found.
These findings agree with those of the SCARPOL study
where children exposed to environmental tobacco smoke
at home, and particularly to maternal smoking, suffered
more often from respiratory symptoms [12].
Theoretically, the educational level of the parents
and the living standard of the family play an important
role in the prevalence of respiratory system disorders,
in the sense that children who receive increased parental
attention and do not share bedroom facilities with others
(a predisposing factor for the transmission of infectious
respiratory diseases) may be protected. We found
significant differences regarding the occurrence of
respiratory diseases in children from families with a
lower living standard and educational level. An
important question relates to the occurrence of frequent
2005 Esmon Publicidad
 Effects of environmental pollution on the respiratory system of children
pulmonary infections in children because of crowding
in nursery schools from an early age. In our study,
children who were hosted in nursery schools during
infancy and early childhood, were observed to present
pulmonary diseases more often.
In general, the questionnaire analysis for the
investigation of respiratory diseases poses some intrinsic
difficulties. Answers were given based on the memory
and sensitivity of the parents. However, our study also
used completely objective indexes, such as spirometry
and rhinomanometry. Indeed, mean FEV1 was lower in
the children of Ptolemaida and higher in the children of
Grevena. Moreover, rhinomanometrically, low nasal
flows were recorded in the cities of Ptolemaida, Kozani
and Florina; three cities with particulate pollution,
compared to Kastoria and Grevena. It had been reported
that the repetition of respiratory infections during
childhood is related to a high diminution rate of the
respiratory function during adult life since the effect of
smoking is added [33]. The consequences of the findings
of this investigation on the respiratory system status
during adulthood are not easily predictable. The long-
term follow-up of the respiratory function of these
children could eventually give an answer to the above
question and should be the aim of further investigation.
Acknowledgment
Special thanks to the General Secreteriat of the
Region of Western Macedonia for the financial support
of this study and to the teachers of the primary schools
for their valuable assistance.
References
1. Burrows B, Knudson RS, Lebowitz MD. The relationship
of childhood respiratory illness to adult obstructive airway
disease. Am Rev Respir Dis 1977, 115: 751-760.
2. Tepper R. Airway reactivity of infants a positive response to
metacholine and metaproterenol. J Appl Physiol 1987, 62:
1155-1159.
3. Lesouef PN, Geelhoed GC, Turner DJ, Morgan SE, Landau
LI. Response of normal infants to inhaled histamine. Am
Rev Respir Dis 1989, 139: 62-66.
4. Martin AJ, McLennan LA, Laudan LI, Phelan PD. The
natural history of childhood asthma to adult life. Br Med J
1980, 280: 1397-1400.
5. Hopp RJ, Bewtra AK, Nair NM, Watt GD, Townley RG.
Metacholine inhalation challenge studies in a selected
pediatric population. Am Rev Respir Deis 1986, 134: 994-
998.
6. Invine J, Brooks A, Walled R. The role of air pollution,
smoking and respiratory illness in childhood in the
development of chronic bronchitis. Chest 1980, 77: 251-
253.
7. Wyler C, Braun-Fahrlander C, Kunzli N, Schindler C,
Ackermann-Liebrich U, Perruchoud AP, Leuenberger P,
Wuthrich B. Exposure to motor vehicle traffic and allergic
sensitization. The Swiss Study on Air Pollution and Lung
Diseases in Adults (SAPALDIA) Team. Epidemiology 2000;
11: 450-456.
2005 Esmon Publicidad
122
8. Riediker M, Monn C, Koller T, Stahel WA, Wuthrich B. Air
pollutants enhance rhinoconjunctivitis symptoms in pollen-
allergic individuals. Ann Allergy Asthma Immunol 2001;
87: 311-318.
9. Goten Al, Goldsmith JR. Epidemiology of childhood
respiratory disease in Israel. Eur J Epidemiol 1986, 2: 139-
150.
10. Peat JK, Woolcock AJ, Leader SR, Blackburn CR. Asthma
and bronchitis in Sydney schoolchildren. II. The effect of
social factors and smoking on prevalence. Am J Epidem
1980, 111: 728-735.
11. Charlton A. Childrens coughs related to parental smoking.
Br Med J 1984, 228: 1647-1649.
12. Hajna BL, Braun-Fahrlander C, Grize L, Gassner M,
Varonier HS, Vuille JC, Wuthrich B, Sennhauser FH. Effects
of environmental tobacco smoke exposure on respiratory
symptoms in children. SCARPOL Team. Swiss Study on
Childhood Allergy and Respiratory Symptoms with Respect
to Air Pollution, Climate and Pollen. Swhweiz Med
Wochenschr 1999; 129: 723-730.
13. Hasselblad V, Humble CG, Graham MG, Anderson HS.
Indoor environmental determinants of lung function in
children. Am Rev Respir Dis 1981, 28: 239-251.
14. Braun-Fahrlander C, Vuille JC, Sennhauser FH, Neu U,
Kunzle T, Grize L, Gassner M, Minder C, Schindler C,
Varonier HS, Wuthrich B,. Respiratory health and long-term
exposure to air pollutants in Swiss schoolchildren.
SCARPOL Team. Swiss Study on Childhood Allergy and
Respiratory Symptoms with Respect to Air Pollution,
Climate and Pollen. Am J Respir Crit Care Med 1997; 155:
1042-1049.
15. Sichletidis L, Daskalopoulou E, Tsiotsios I, Chloros D,
Vlahogiannis E, Ziomas I, Zerefos Ch, Vamvalis Ch. The
effect of pollution on the respiratory system of children. Hell
Iatr 1994, 60: 210-218.
16. The ISAAC Steering Committee. Worldwide variations in
the prevalence of asthma symptoms: the International Study
of Asthma in Childhood (ISAAC). Eur Respir J 1998, 12:
315-335.
17. Ferris BG. Epidemiology standardization project. Am Rev
Respir Dis 1978, 118: 1-120.
18. Goren AI, Hellmann S. Prevalence of respiratory symptoms
and diseases in schoolchildren living in a polluted and in a
low polluted area in Israel. Environ Res 1988, 45: 28-37.
19. American Thoracic Society. Standardization of spirometry
- 1987 update. Am Rev Respir Dis 1987, 136: 1285-1298.
20. Clement PAR. Committee report on standardization of
rhinomanometry. Rhinology 1984, 22: 151-155.
21. Air Quality Guidelines of Europe, Copenhagen: World
Health Organization, Regional Office for Europe 1987,
WHO regional publication European Series N 23 p 357.
22. Speizer FE, Frank NR. The uptake and release of SO2 by
the human nose. Arch Environ Health 1966, 12: 725-731.
23. Grahma DH, Koren HS. Biomarkers of inflammation in
ozone-exposed humans. Comparison of the nasal and
broncholveolar lavage. Am Rev Respir Dis 1990, 142: 152-
160.
24. Sichletidis L, Daskalopoulou E, Tsiotsios I, Gavrilidis A,
Chloros D, Vamvalis C, Michaelidis K, Ziomas I, Zerefos
C. Atmospheric air pollution of Eordea valley. Incidence on
the health of inhabitants. Hell Iatr 1997, 63: 391-400.
25. Freeman G, Grane SC, Furiosi NJ, Stephens RJ, Evans MJ,
Moore WD. Covert reduction in ventilatory surface in rats
during prolonged exposure to subacute nitrogen dioxide. Am
Rev Respir Dis 1972, 106: 563-579.
26. Neas LM, Dockery DW, Ware JH, Spengle JD, Speizer FE,
Ferris BJ. Association of indoor nitrogen dioxide with
J Invest Allergol Clin Immunol 2005; Vol. 15(2): 117-123
123 L. Sichletidis, et al.
respiratory symptoms and pulmonary function in children.
Am J Epidemiol 1991, 134: 204-219.
27. Honicky RE, Osborne JS, Akpom CA. Symptoms of
respiratory illness in young children and the use of wood
burning stoves for indoor heating. Pediatrics 1985, 75: 587-
593.
28. Sherrill DL, Enright P, Cline M, Burrows B, Lebowitz MD.
Rates of decline in lung function among subjects who restart
cigarette smoking. Chest 1996, 109: 100: 1-5.
29. Somerville SM, Ronia RJ, Clinn S. Passive smoking and
respiratory conditions in primary school children. J
Epidemiol Community Health 1988, 42: 105-110.
30. Martinez FD, Antognoni G, Macri F, Bonci E, Midulla F,
DeCastro G, Ronchetti R. Parental smoking enhances
bronchial responsiveness in nine-year old children. Am Rev
Respir Dis 1988, 138: 518-523.
31. Soyseth V, Kongerud J, Haarr D, Strand O, Bolle R, Boe J.
Relation of exposure to airway irritants in infancy to
prevalence of bronchial hyper-responsiveness in
schoolchildren. Lancet 1995, 345: 217-220.
J Invest Allergol Clin Immunol 2005; Vol. 15(2): 117-123
32. Lebowitz MD, Holberg CJ, Kundson RJ, Burrows B.
Longitudinal study of pulmonary function development in
childhood, adolescence and early adulthood. Am Rev Respir
Dis 1987, 136: 69-75.
33. Shaheen SO, Barker DJ, Holgate ST: Do lower respiratory
tract infections in early childhood cause chronic obstructive
pulmonary disease? Am J Respir Crit Care Med 1995, 151:
1649-1651.
Lazaros Sichletidis,
Laboratory for the Investigatio of Environmental Diseases
Pulmonary Clinic, Aristotle University of Thessaloniki
G. Papanikolaou Hospital, Exochi, Thessaloniki
GR-57010
Tel.: +302310260858 - Fax: +302310350316
E-mail: dchloros@msn.com
2005 Esmon Publicidad